Conference Notes cont…

This is part 2 of my review of Dr. Maloney’s lecture on “The Critically Ill Neonate in Your Community ED.”

After introducing the Pediatric Assessment Triangle, Dr. Maloney reviewed some unique considerations with pediatric ABC’s.

Airway

1.  Because of the baby’s big occiput and flexible neck and trachea, use a shoulder roll to help with visualization

2. Babies have a higher, more anterior glottis, so “look up, pull back”

3.  Used cuffed tubes for any pediatric intubation.  This is a change from previous PALS guidelines

Breathing

1.  Disable the “pop-off valve.”  Instead, watch for chest rise and let that guide your bagging

Circulation

1.  IO is the preferred method for access in a sick baby.

2.  The umbilical vein can be used up to 7-10 days.  Use a 20 gauge angiocath or 5 French feeding tube.

Here are some additional take-home points from the lecture

1.  Eating is the neonates cardiac exercise stress test.  Be very concerned for complaints such as sweating when eating.

2.  The hypoxia test is like the “poor man’s echo.”  To perform this place the baby on 100% FiO2 for 5-10 minutes.  Then get an ABG.  If the PaO2 is less than 100, this is highly suspicious for a congenital heart defect.  If the PaO2 is more than 250, a congenital heart defect is unlikely

3.  Should you intubate prior to transport when you give PGE?  Probably.  Consider transport time and the training of your transport team.  The major concern is for apnea and hypotension with administration of PGE.

4.  Mnemonic for differential diagnosis in neonatal emergencies:

THE MISFITS (developed by Tonia J. Brousseau, DO   Ghazala Q. Sharieff, MD)

Trauma

Heart disease/hypovolemia

Endocrine

Metabolic

Inborn errors (if glucose, ammonia, urine ketones, and lactate normal ——> unlikely)

Seizure

Formula problems

Intestinal emergencies

Toxins

Sepsis

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